1. Field of Invention
This invention pertains to a method for reduction and fixation of fractures, such as a proximal humeral fracture.
2. Description of the Related Art
Reducing a proximal humeral fracture requires that the proximal ends of the fracture by brought together and fixed. One technique for reducing and fixing such fractures is intramedullary nailing. Often intramedullary nailing results in inadequate fixation in the osteoporotic humeral head. Also, insertion of the intramedullary nail requires the surgeon to split the rotator cuff and destroy a portion of the superior aspect of the humeral head articular cartilage. Although intramedullary nailing may be effective in certain types of fractures, the damage to the rotator cuff and articular surface of the humeral head often outweighs the benefits of intramedullary nailing.
Closed reduction and percutaneous pinning is another technique for reducing and stabilizing proximal humeral fractures. The closed reduction avoids using an incision to access the fractured bones. The fracture is reduced by manual manipulation of the body. With the fracture reduced, metal pins or wires are inserted though the skin to fix and immobilize the fracture. The percutaneous pinning is often not well tolerated by patients, and the technique requires patient compliance to ensure a successful outcome.
Another technique for reducing and fixing proximal humeral fractures uses a plate that is fixed proximate to and bridging the fracture. The plate, commonly called a bone plate, is a rigid structure fixed to the head and the diaphysis after the fracture is reduced. The plate is attached to the bone by screws. Typically, the fracture is reduced by manually manipulating the head through an incision to move the head out of varus or other malalignment. The head is provisionally pinned and then the bone plate is fixed around the provisional fixation. Manual manipulation of the head oftentimes requires an enlarged incision to provide access to the head and, also, often results in damage to the soft tissue surrounding the head. Fixing the bone plate often results in soft tissue stripping. Although the bone plate potentially is capable of fixing the head and diaphysis after reduction, it is often difficult to reduce the fracture and maintain alignment while the bone plate is being fixed in place.